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PHS/SAN JOA*N COUNTY - ENVIRONMENTAL GALTH DIVISION <br /> - CONTAMINATED SITE MFR - INPUT FORM <br /> UPDATE / / BY REVIEWED BY DATE ENTERED BY, <br /> ADDITION: <br /> SWEEPS # COMPUTER # DIST # LOC CODE <br /> 199 <br /> UGT FILE H W FILE LAND USE FILE RWS FILE '=,ILOT PRCG I <br /> FAILED PT / / SOIL CONT I ge / /,?o GW CONT / / DW CUNT <br /> PETROLEUM( Y N ENTERED PILOT / / FROG/ELEMENTT. <br /> SITE NAME <br /> ADDRESS RHONE <br /> CITY <br /> STATE CA Z T F' <br /> CONTACT NAMECROSS STREET <br /> PROPERTY OWNER <br /> NAME PHONE <br /> MAILING/STREET ADDRESS <br /> CITY STATE Z IES <br /> CONTACT NAME RHONE <br /> RESPONSIBLE PARTY (If different from Property Owner,) <br /> COMPANY ;NAME PHONE <br /> CONTACT NAME PHONE <br /> ADDRESS <br /> CITY STATE <br /> CONSULTANT PHONE <br /> SJ/EH CONTACT <br /> RWQCB CONTACT <br /> DHS CONTACT <br /> OTHER CONTACT <br /> UAR # DATE / / PROP 65 # ko -OCADATE / <br /> qo <br /> STREET # SITE STREET <br /> PRIORITY <br /> EH 23 070 (7/89) 89-19 (IV)7/89 CNTMFR <br /> a <br />